Later in the run, he returned for additional edification, Ralph Nader and Joan Claybrook in tow. The upshot?

Among the three major contenders in Campaign 2000, only George W. Bush had failed to laugh—and of course to learn—at the award-winning exposition!

Who is Russell Mokhiber? Then, as now, he was one of Washington's leading chroniclers of "corporate crime." In 1999, Diana Henriques actually wrote a whole column about him at the Washington Post:

HENRIQUES (9/26/99): What the police blotter is to the world of street crime, Russell Mokhiber's weekly newsletter is to corporate America.

For the last 13 years, the Corporate Crime Reporter has been itemizing misdeeds committed by highly esteemed members of the Fortune 500: antitrust violations, environmental crimes, Medicare fraud, financial swindles and the neglect of workplace hazards.

After so many years on the mean streets, Mr. Mokhiber's opinion of the nation's most admired corporate citizens is somewhat jaundiced.

''Corporate crime is crime without shame,'' said Mr. Mokhiber, who works in a one-man office in the National Press Building here. ''It's gotten to the point where when a corporation pleads guilty to some criminal act, the stock goes up.''

[...]

A lawyer and a longtime follower of the consumer advocate Ralph Nader, Mr. Mokhiber first drew a bead on the corporate world in 1988 with his book, ''Corporate Crime and Violence: Big Business Power and the Abuse of the Public Trust.''

We thought of Mokhiber a few weeks back as we perused a new book. The book was written by Elisabeth Rosenthal, a well-informed person who generally lacks Mokhiber's street-fighting profile.

Who is Elisabeth Rosenthal? Her publisher, Penguin Random House, profiles her at her book's site. For twenty-two years, she was a reporter, correspondent, and senior writer at The New York Times.

Today, Rosenthal is editor in chief of Kaiser Health News, an independent journalism newsroom focusing on health and health policy.

She wasn't always a journalist. Rosenthal started out as an MD from Harvard Medical School, trained in internal medicine. Her new book, An American Sickness, "is a shocking investigation into our dysfunctional healthcare system," Penguin Random House accurately says.

Rosenthal is a deeply experienced person who isn't a street-fighting radical from the Nader school. As we started reading her book, we thought of Mokhiber because of the way, in her opening pages, she adopts the language of corporate crime in describing our health care system.

This very week, the health care "system" her book describes will be all over the nation's front pages. On our corporate "cable news" channels, top stars will pretend to discuss it.

As this happens, Rosenthal's horrific book is withering on the vine. Despite its author's unassailable pedigree, the book is producing zero public discussion, a point we'll consider all week.

Rosenthal's book is being widely ignored. That may be because of the way its author adopted the language of corporate crime in discussing our "health care system."

In what ways does Rosenthal channel Mokhiber? Right on page one, in her opening sentence, the dignified author says this:

ROSENTHAL (page 1): In the past quarter century, the American medical system has stopped focusing on health or even science. Instead it attends more or less single-mindedly to its own profits.

"The American medical system...attends more or less single-mindedly to its own profits?" Can Elisabeth Rosenthal say that?

We think you're asking a very good question. But trust us, that's barely a start.

As she continues, Rosenthal repeatedly describes the working of our health care system in the language normally used in the description of crime. This may help explain why wealthy corporate employees on cable channels will never, not in a million years, discuss the things Rosenthal says.

In what ways does she talk Mokhiber's talk? "Faced with disease, we are all potential victims of medical extortion," she says on page 3. By page 4, she's offering this:

ROSENTHAL (page 4): Part 1 of this book, “History of the Present Illness and Review of Systems,” charts the transformation of American medicine in the last quarter century from a caring endeavor to the most profitable industry in the United States—what many experts refer to as a medical-industrial complex. As money became the metric of good medicine, everyone wanted more and cared less about their original mission. The descent happened sector by sector: insurers, then hospitals, doctors, pharmaceutical manufacturers, and so on.

First as the child of an old-fashioned doctor—my father was a hematologist—then as an MD, and finally during my years as a health care reporter for the Times, I’ve had a lifetime front-row seat to the slow-moving heist.

She's had a front-row seat at a slow-moving heist? She's speaking the language of crime.

In her very next paragraph, Rosenthal adopts the language of corporate insult. She says the "big players" in our "medical-industrial complex" "spend more on lobbying than defense contractors."

In the process, they persistently "default to the most expensive treatment for whatever ails you," she says, describing a process which almost sounds a small tiny bit like fraud.

Comparisons to the military-industrial complex don't literally entail the use of the language of crime. That said, they come rather close. And at the start of Chapter 2, still on page 24 of her book, Rosenthal lets it fly.

She approvingly quotes a health care expert who compares the operation of American hospitals to the work of our nation's most famous bank robber. Then she quotes another expert making an ugly allusion.

Why do hospitals charge so much? This is what Rosenthal says:

ROSENTHAL (page 24-25): "It's like asking Willie Sutton why he robs banks; that's where the money is," said Dr. David Gifford, a former director of the Rhode Island Department of Health. Market economists I've spoken with variously refer to hospitals as "sharks" or "spending machines."...

A longtime finance executive with major American hospitals describes his field as an extractive industry...

Rosenthal doesn't identify that longtime finance executive, who she proceeds to quote. The executive goes on to describe an array of players who are "at the trough" as hospitals execute their various heists.

"This is not a healthcare system, it's an industry," this longtime executive says, "and at every point there's away to make money."

Some of this language is simply the language of corporate denigration. But some of this is, quite clearly, the language of corporate crime.

We thought of Mokhiber as we read it. Beyond that, we pondered the fact that you will never hear these topics discussed by your favorite TV stars on the partisan entertainment channels billed as "cable news."

Rosenthal hails from Harvard Medical School and the New York Times. She hails from the very top of our major elites—and she speaks the language of corporate crime when she describes our health care system, which she calls "An American Sickness."

Its practitioners are staging a rolling "heist;" they engage in repeated acts of "extortion." They are compared to Willie Sutton, one of our most famous criminals.

Rosenthal makes these statements from the highest peaks of our modern elites. That said, she won't be speaking with Rachel or Lawrence this week. All week, we'll ponder the reasons for that.

We'll also ponder the startling data you won't be seeing on your favorite cable programs this week. You won't be asked to marvel at these data, or to ponder the extent to which your nation is a helpless, pitiful giant in thrall to a large group of extractive players:

34 comments:

According to No More Mister Nice Blog, the conservative press isn't even reporting on the Health Care Bill today.

When the language of crime is used to describe the functioning of an industry, the author is not producing a thoughtful analysis. She is writing a hit piece. I'd like to know what produced her jaundiced description. Is she mad at her father, or did she get turned down for some job, or did someone die who she cared about? When this kind of language is used, things are obviously personal.

She worked part-time in a NYC emergency room before quitting medicine. Not exactly a medical career and not much breadth of exposure to the health care industry. She apparently didn't like medicine. Since her father was a doctor, wonder if she was forced into it or influenced by her dad then disillusioned. Rejecting the whole business along with her personal choice as a justification for quitting medicine without rejecting her dad perhaps.

The bottom line is that all of that extra money (billions and billions) is going somewhere, despite no improvement in medical outcomes. Are hospital buildings only built in high-rent districts? Are hospital workers paid way too much? Are we subjected to too many expensive procedures? The problem is that no-one in the media apparently wants to find out the answers to these questions and tell us about it. Rosenthal's answer fits. The health care industry is deliberately designed to maximize profits (not health outcomes). This is good business, but not good public policy.

"The bottom line is that all of that extra money (billions and billions) is going somewhere, despite no improvement in medical outcomes."

Same could be said for education as well.

One might think that these sectors are perpetuated as make work programs for the over educated and credentialed. It would actually be more cost effective to fly patients overseas and have them treated out of the country than to pay for service here. Can't have cost reductions however, it would make too many people redundant.

The apologist for the medical industry might want to read Rosenthal's book (I haven't read it but have read her NYT columns on the subject). Granted TDH simplifies something that is extremely complex, and probably near intractable. All this money is going somewhere, and those who are getting it will fight, viciously if they have to, to hold onto it, and the stock market could take a big hit which would hurt a lot of people directly or indirectly. That said, there should be way more discussion about Rosenthal's book and subject matter - more than a stray interview on NPR. Why shouldn't Maddow spend a lot of time on the subject, instead of the day after day tripe she comes up with, and the same could be said for the rest of the so-called liberal media.

Anonymous at 12:54pm: "Same could be said for education as well. ". Yes, it goes to for-profit colleges that deliver sub-standard education. All the profits in the healthcare system go to for-profit entities that deliver sub-standard healthcare. A very good analogy indeed.

This is nonsense. Most health care organizations are non-profit. Some are for-profit. Lumping their practices all together is misleading.

I have no problem with government-run healthcare because I think this is a common need that can and should be administered for the public good. But ours is a capitalist country and we have not chosen to create such a system. Blaming the health care industry for the flaws of the capitalist system in general, and blaming doctors specifically, seems simple-minded to me. I can see Bernie-types going through this kind of exercise because they are typically 20 year olds who haven't thought much about anything. But getting upset because there is profit involved (often large profits) in any industry strikes me as majorly immature. Nader did this kind of expose of the car industry. You can do the same thing with any segment of our economy. We live in a profit-making, capitalist country that is wasteful, unfair to the poor, expensive to its citizens, and inefficient in serving the public. But that's how we do things. If you have serious suggestions for improving ACA, send them to your congress person. Otherwise, grow up.

There is a genre of non-fiction involving outrage. It satisfies the same need as watching Fox News. I call it "ain't it awful" books. I'm sure there are plenty of examples in her book that will raise the blood pressure of anyone who wastes time reading it.

Burnout among doctors is around 10 years. Maybe that is a good measure of how long it takes them to pay back their student loans. Glad she found a niche in journalism, but I wouldn't consider her an expert on medical practice or health care or public health policy. She organizes the articles of other people to put together Kaiser's magazine. You cannot read any nonfiction without asking yourself what the author's axe to grind arises from. This one is obvious.

"Same could be said for education as well. ". Yes, it goes to for-profit colleges that deliver sub-standard education. All the profits in the healthcare system go to for-profit entities that deliver sub-standard healthcare. A very good analogy indeed."

There are plenty of non-profit colleges and universities that deliver substandard education as well. The profit motivation has little to do with it if you consider that those who run the organizations make money whether students are properly educated or not.

Do the non-profit hospitals charge less than the for profit ones? Why would they leave money on the table? All non-profit means is that they just don't provide dividends for share holders. I would surmise that most people would be surprised at how little of total revenue those profits to share holders are. The non-profits just use that money to expand, expand, expand. New wings, fancy birthing centers, extra revenue generating facilities in the name of access. Those who run non-profits make plenty of dough and keep on growing. Same with colleges and universities. In both sectors there is very little market action or accountability.

Most healthcare is non-profit? This statement is nothing short of delusional. From incredibly high doctor's fees to over-priced medical devices (see Blumenthal's article on hip implants) to unimaginably high cost of pharmaceuticals -- everything in our medical healthcare delivery system is not only for-profit, it's for-outrageous-profit, which would not be sustainable in any other industry. The fact that some hospitals or insurance companies call themselves non-profit is just a shell game. They all serve to shovel money at a bloated industrial-medical complex.

The educational system is sort of following the same model. It's not that there are better or worse colleges. It's that there's a for-profit education industry whose ostensible purpose is to use students as straws to suck out federal loans. No other purpose exists for them.

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"...but how do participants in the marketplace make purchasing choices? Prices are often unknowable and unpredictable; there’s little robust competition for our business; we have scant information on quality to guide our decisions; and very often we lack the power ourselves to even make the decisions."

1. People do not consider health care a commodity. They do not make "purchasing choices." They go see a doctor who they trust and believe will help them whenever they feel sick enough to be anxious that something is wrong with them.2. There are many doctors, so many that people do not shop around for one. They ask a friend or relative who they see and then try that person for themselves. If they are treated kindly and like the doctor, they go back. If they have a bad experience, they look for someone else.3. No one asks prices ahead of time because they only see the doctor when it is absolutely necessary, so they will see the doctor regardless of price, so why ask. For those who are insured, the price will mostly be paid by insurance and the actual cost to them will be revealed by a later bill. This is far different than the way people "shop" for other things.4. There is a great deal of competition. In most areas there are many doctors to choose from. In rural areas, there is little competition but the doctors are members of the community. They present themselves as friends instead of commodities to be purchased.5. Because people are incapable of evaluating the qualifications of a doctor, they rely on accreditation and licensing. This is the same as occurs in any profession. Minimal standards for competence and training are established by the profession. Doctors must renew their credential periodically by examination. Complaints can be made to licensing bodies (usually the state).6. Despite lacking the ability to make an informed quality-related decision, we do the choosing.

HMOs change this up. You choose the HMO (presumably based on customer satisfaction ratings or reviews) and the HMO sets standards for its employed doctors. You can then see any doctor who is part of the HMO. Preferred Provider networks are a hybrid of this.

Despite being unqualified to assess a doctor's competence on any basis except social interaction, people place high value on the ability to choose, often opting for a higher cost insurance plan that allows them to see who they want, instead of an HMO which will cover their entire costs except for a minimal ($10-20) copay.

This author insists on treating health care as if it were a commodity instead of a necessary service that shouldn't be offered on a free market basis. The rest of the "outrage" follows from that initial mistake. Maybe our society will wake up and change the way it pays for health care, but until then, this problems will remain because no one will participate in a market unless they can make money.

My own experience with health care suggests that the poor outcomes result from the individual freedom permitted in the US, the lack of peer pressure toward healthy lifestyle choices, and the right people insist upon to delay seeking treatment, ignore doctor treatment plans (lack of compliance), and seek alternative health care without telling the physician, even to the point of visiting other countries to obtain illegal care. People sabotage their own health care. Unless that is factored into the picture, cross-cultural comparisons are meaningless.

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Having been a member of Dr. Rosenthal's facebook group within a few months' of it starting, I have found her compassionate, balanced and caring...

Among other things, in no other Western democracy do we see where people worry about becoming bankrupt due to medical bills.

Whether you think the Republicans or the Democrats are "right" -- there's certainly been a stated concern about the unaffordability of healthcare in the U.S. -- whether you want to think PPACA is fault (it's not, the prices were escalating rapidly long before Obama became President) or whether you think PPACA could hold the answer if the Republicans weren't stonewalling the things which would make it effective...

...both sides see rapidly escalating health care costs with no end in sight.

It's not a matter of capitalism; it's a matter of how capitalism is twisted.

Rosenthal does not view healthcare as a commodity--rather, her statements are written to counter those who thing standard economics should drive health care costs down in a capitalist society...that is the primary argument of those who wish to see ZERO involvement in the healthcare system by the government...

...but it's clear that the capitalistic intentions of the players overtake even the minimal government intervention attempted (for instance, medicare cannot negotiate drug prices...something which every other Western democracy DOES.)

When we see the likes of Shrkeli radically escalate the price of drugs...and he is not alone; where pharmaceutical companies drastically increase the cost of epipens after previously making it REQUIRED to be purchased by schools and other public institutions...Or when the price of narcan is drastically escalated...one of the most highly effective antidotes for narcotic overdoses for over 40 years...

Something's not right.

When the average salary of a hospital CEO is > $500,000 -- and most CEOS of any size pull in a salary of over 7 figures a year...what kind of society are we living in?

The sweet and short is that US citizens pay 2x as much for less effective healthcare than in other modern democracies.

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